Treatment of Angioedema Without Urticaria in Patients on an ACE Inhibitor or ARB
Isolated angioedema without urticaria — often localised to the head, neck, lips, mouth, tongue, larynx, pharynx, and subglottal regions — is a recognised complication in patients taking an ACE inhibitor or an angiotensin receptor blocker (ARB). Up to 68% of cases of isolated angioedema are attributable to an ACE inhibitor, and ARB-associated cases are managed identically.
Clinical Scenario
This protocol applies when a patient presents with isolated angioedema and no urticaria while taking an ACE inhibitor or ARB. The affected areas are frequently the head, neck, lips, mouth, tongue, larynx, pharynx, and subglottal regions — a distribution that requires careful attention to airway status.
Management Overview
Management centres on addressing the causative medication and ensuring airway safety, with supportive measures and certain adjunctive agents that may be considered — though the evidence supporting those adjunctive options in this specific setting is limited.
Full sequencing, decision points, and clinical details are in the complete protocol →
References
- Clinically, ACE inhibitor angioedema presents without urticaria.
- Up to 68% of cases of isolated angioedema are due to an ACE inhibitor.
- Edema is often localized to the head, neck, lips, mouth, tongue, larynx, pharynx, and subglottal regions.
- The management of patients with ARB angioedema is identical to that of patients with ACE inhibitor angioedema.
- Treatment of patients with ACE inhibitor angioedema focuses on discontinuation of the drug, airway management, and supportive care.
- Epinephrine, antihistamines, and corticosteroids can be given to these patients; however, there are no controlled studies that demonstrate the efficacy of the medications in this setting.
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